The NAIC is looking for ways to put the kibosh on these kinds of schemes, which cost the carriers - and, ultimately its policyowners and stakeholders - big bucks. Their first move has been to "[urge] insurers to conduct due diligence with detection methods." They could start, as we noted in February, by "[seeking] information about the buyer's relationship to this annuitant."

Of course, this presumes a certain intelligence on the part of Home Office Critters.

Given the topic of this post, it would have been even more helpful to know the breakdown of how many "regular" doc's feel that way vs how many "hospital" doc's concur. Alas and alack, we'll have to make do.

I am fortunate to have a number of physician clients, one of whom was willing to discuss the issue with me at some length. Bill (not his or her real name) and I spoke for almost an hour on this subject, and he was quite candid about what he's seeing. It helps to know that he practices in a town with just one local hospital, and we discussed the implications of that, as well:

IB: What can you tell us about ACO's [Accountable Care Organizations]?

Bill: First, this is a major hot-button issue with physicians; hospitals have become quite predatory, because they're in the driver's seat. The model for this is Medicare's "capitation" system, which is in place around the country. Basically, Medicare cuts one check, to the hospital, which then "divvies it up" to the various providers involved. So the hospital keeps some for the OR, the anesthesiologist gets a cut, the surgeon gets one, etc. Right now, the hospital can pay an outside physician, but the ACO model changes that.

IB: What do you mean?

Bill: With ACO's, the hospital can only pay physicians who are credentialed and the model encourages economic credentialing [ed: more on that in a moment]. So if I have a patient who needs, say, an earectomy, and I do that at XYZ Memorial Hospital, I can't get paid for that or, if I fight it, it's a major hassle.

IB: Well, some would say that this isn't necessarily a bad idea; after all, we've been trying for a while to get global billing on the table.

Bill: There's that, but this is different. The idea behind global billing is that the patient gets one bill, and everything's disclosed. This is different, because the hospital gets a check, and it's got to disburse the money to the various doctors and other providers. And then there's a major catch called "economic credentialing" [EC]. What EC does is look for which doctor does a given procedure the cheapest. Now, there's a counter-balance to that, because outcomes are also part of that equation: if he's doing it cheap but has a lot of follow-up care because of complications and the like, that counts against him.

Wednesday, October 27, 2010

As we noted earlier this year, the actual administration of a Health Savings Account can pose some interesting challenges. That's why we recommend a local expert to our own clients, and why I'm a proponent of the "you get what you pay for" school of thought.

A recent personal experience has only underscored the importance of that advice. For many years, we were covered under my spouse's group insurance, an HSA plan to which her employer also contributed. A few months ago, she left that job to pursue a dream, starting her own business (which is both exciting and terrifying). Subsequently, we switched our insurance over to my employer's plan, which is also an HSA.

The "old" group insurance plan used Chase Bank as its HSA administrator, and we could have stayed with them when we made our change. But I'm a big believer in taking my own advice, so we immediately contacted our local HSA gurus at FlexBank.

And boy, am I glad we did.

Over the course of just a few weeks, we had a number of issues come up (not the least of which was that we couldn't just start a new account in my name and transfer the money from an account in hers). Needless to say, we've had numerous phone conversations and exchanged a few emails. Throughout, the folks at FlexBank have been professional, courteous and - above all - knowledgeable about the various intricacies of our situation.

"Shanda" is a Yiddish word meaning "scandal" (it also implies shame and embarrassment). And it's an entirely appropriate description of how the AMA should feel. Although it purports to represent all physicians, its membership comprises fewer than 1 in 5 of them. Yet it wields power completely out of proportion to its membership:

It's not enough that they own, and profit substantially from, the diagnostic codes required for reimbursement from Medicare and insurers:

"The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work."

And the dollar amounts are astounding: over $60 billion a year from Medicare alone. Elected by no one, accountable only to themselves, these physicians (who, by the way, aren't even necessarily the best in their own fields) control vast sums of our dollars, both directly and indirectly.

Tuesday, October 26, 2010

One of the stated reasons for John Hancock's recent rate hike on some of its Long Term Care (LTCi) business was its large book of government-employee business. No surprise, but apparently gummint workers generated far more claims than anticipated.

And how likely is that? The Congressional Budget Office (CBO) thinks it's not only likely, but a near-certainty:

"Because the law requires the CLASS program to enroll all eligible individuals who apply, CBO said it is “likely that some enrollees would be people who were unable to obtain coverage in the private market because of their poor health status."

The SS Obamacare is barely out of the harbor and is already taking on water. Last month HHS was forced to grant Obamacare waivers to 30 companies including McDonald's restaurants. The waivers will allow those companies to bypass some of the mandates in Obamacrap and continue to offer limited benefit health insurance plans to thousands of their employees.

Now it appears HHS it poised to cave on other portions of Obamacrap to avoid a chain reaction of large employers who are considering the cancellation group health insurance plans for their employees unless they are granted waivers as well. According to KHN, many employers are weighing the cost of implementing Obamacrap vs. dropping coverage.

an executive for the consulting firm Deloitte said, "What we are hearing in our meetings is, 'We don't want to be the first one to drop benefits, but we would be the fast second.' We are hearing that a lot."

Of course the White House is claiming that there is no merit to the proposed action.

'It could work out well and build on the employer-based system, or it could begin to dismantle the employer-based system.'"

Even the idiots in Washington know they cannot take on providing health insurance for everyone, and a cornerstone of Obamacrap relies on roughly 160 million keeping the plan they have now. As Obamacrap continues to roll out, the Medicaid rolls are expected to swell by 15 - 20 million and those individuals will be supported by new taxes at the state and federal level. Large employers who do not provide health insurance for their employees, or who drop coverage will be subject to a nominal fine. The $2,000 fine per employee is peanuts compared to what employers are paying now in premium subsidies for their employees.

The slap on the wrist fines make it a no brainer when it comes to employers choosing to continue health insurance or drop it and pay the fine.

Of course Washington specializes in no brainers . . .

to entice employers to keep benefits, the White House may waive requirements that would make it easier for them to offer new health plans that don't have to meet all requirements of the law

First McDonald's, now this.

When are the rest of us going to be exempted? Don't we deserve a break today too?

And while we are on topic, how well are those pools for people with pre-existing medical conditions working?

In Missouri, where an official said people were complaining because they thought the plans were free, the experience has been typical of many states. "The monthly premium in Missouri is as high as $972 a month; the program has only had about 140 enrollees since opening this summer.

I guess too many people thought Obamacrap was going to be free. Heck, even the president acknowledged a few weeks ago they knew they could not cover 40 million people for free.

Too bad the people who voted these clowns in to office didn't realize that.

The SS Obamacare is headed for an iceberg and the casualties will make the Titanic look like a minor accident.

We've made this same argument, of course, but it's startling to hear it from a Democrat governor.

But is it accurate?

You betcha:

That $2000 fine comes to about $166 per employee (per month). Under almost any scenario, that number is less than (often substantially less than) the actual insurance premium for that employee. Add in the cost of administration, and it becomes even more lop-sided in favor of the fine. Add in the intangibles (employee meetings, annual renewal reviews) and the cost savings are obvious and compelling.

That "thud!" you hear is the sound of your current employer-based coverage going under the bus.

Many folks reason that Long Term Care insurance is an unnecessary expense because they have family members who will care for them. And it's true that for non-critical, maintenance-level care, this is an obvious choice (assuming one's children or sibling's are amenable to the idea). What's not so obvious, though, is the cost to the caregiver:

Genworth Financial, one of the LTCi "Big Boys" commissioned the study, based on over 800 adults, both caregivers and those receiving care. The problem is that those giving the care cost themselves major chunks of their own nest-eggs; giving up their ability to contribute to 401(k)'s and the like means that there's less available to them when they need it.

Friday, October 22, 2010

"My spouse is a retiree of [a well-known financial institution]. We are both in our late 50's and on [the former employer's] group health insurance. Our daughter turned 24 last Spring, and "aged off" our insurance due to that event. We were told by the [former employer] in August that she could be added back during open enrollment for coverage effective 1/1/2011 under the new provision of Obamacare, since she is under age 26.

Open enrollment began today and now they've changed their tune. They are now saying that because my wife is a retiree, and not an active participant, that the changes in the law pertaining to dependent coverage do not apply. I have read both the text of the law itself from the Federal Register and the federal regulations promulgated by the IRS, the Dept. Of Labor, and the Dept. Of Health and Human Services. I see nothing that makes this distinction. In fact, the regulations specifically state that even if my daughter were married, or not living with us, she would still be covered. The only exception seems to be, for grandfathered plans, if she were eligible for coverage under a different employer’s group plan, they could exclude her. This does not apply to her.

The [former employer] has promised to research further and get back to me in 5 business days. I asked them specifically to site me the law or regulation that allows them to distinguish a retiree’s dependent coverage from an active employee’s dependent coverage.

Do you know anything that backs up their position, or are they completely wrong, as I suspect? Thank you very much for your help in this matter."

We're always grateful for a challenge, and this one seems both current and important. Here's what I replied:

"You'll find that the employer didn't actually "change its tune," but gave you inaccurate info in the first place. Retiree plans are exempt from that part of ObamaCrap.

Sorry!!

If she's healthy, you might be better off putting her on her own plan, anyway. Often, these are less expensive than dependent coverage on a group plan, and will offer a choice of benefits designs.

Have a GREAT rest of the day!!"

Our reader, being the tenacious sort (which we like), wasn't wholly satisfied with this reply, and (as it turns out), with good reason:

"She does have her own plan, but it’s not very good. Guess we’ll have to shop around for something better for her. Do you know where in the law this exception for retiree plans is? (Sorry, I’m a lawyer, so I like the details).

Thanks for the quick reply."

He's right to call me on this, because he had asked for a specific citation, not just our analysis. Here's my reply:

"Actually, Hank, behind the curtains there's a little more involved than just being a retiree or the dependent of a retiree.

The distinction comes about because, apparently, the former employee and her family are enrolled in a "retiree-only" plan. Since they are both under 65, and presumably not Medicare-eligible, it's possible they could have the same plan (i.e., same benefit design) as the former employer's active employees. The employer's corrected answer tells me that this couple is enrolled in a distinct, retiree-only plan. (HHS says a retiree-only plan can enroll no more than 1 current employee). Thanks in large part to lobbying by AARP, retiree-only plans are, as you point out, exempt from PPACA. Of course, the plan sponsor of a retiree-only plan can voluntarily choose to comply with the reform requirements. But if they claim exemption they obviously can ignore the requirements - and the extra cost that the requirements entail. To claim the exemption, the plan sponsor must certify that the plan covers no more than 1 current employee, that a separate Form 5500 for the plan is filed with DOL, and that there is a separate SPD [ed: Summary Plan Description].

Clearly and in hindsight, the former employer gave them bad information the first time. While learning the truth of the matter may have angered them, I don't see that they "lost" anything they were entitled to. Maybe, if their daughter immediately canceled some other individual policy in anticipation of group coverage, they could claim to have been damaged by relying on the employer's erroneous advice. But that seems unlikely. So I doubt the employer's bad answer has harmed them - at least not in any way that I can see. It just made them angry. I bet there's a lot of plans out there bumping into things in the dark, trying to figure this out. It's almost as though the government deliberately made all this as complex as possible . . . naw, that can't be right . . . .can it?"

Thursday, October 21, 2010

In the insurance world, MFN (no, that's not an acronym for something dirty) means "Most Favored Nation," a term usually reserved for international trade agreements. In this case, it's an agreement between an insurer and a provider (or many providers) which grants the insurer exclusive and substantial discounts on medical services. These are generally perfectly legal, but - as Blue Cross of Michigan has found out, to its chagrin - it's easy enough to cross the line.

In this case, Michigan Blue Cross (BX) is considered the "dominant carrier" in that state's health insurance market (no big surprise). This is a double-edged sword: it means a larger market share, but it also means that they're considered the "carrier of last resort," meaning they absorb a lot of high-claim insureds, as well.

Being the dominant carrier has at least one advantage: they can demand - and get - much greater discounts from medical service providers (e.g. hospitals). That makes sense, too: greater numbers of insureds mean greater numbers of patients that can be funneled to network providers. It's a win-win situation.

These discounts can be huge, by the way: up to 15% (or more!) off covered services. This helps the carrier two ways: one, it lowers their claims costs, which helps ameliorate rates (to a point). It also means that their insureds have less out-of-pocket, which is good PR, and helps with retention.

So where's the beef?

In a nutshell, it appears that BX decided to up the ante, and not only get their own discounts, but force providers to reduce the discounts they offered to other insurers. That's a double whammy, because it means an even greater reimbursement differential, and thus higher claims costs, for the other, non-dominant carriers.

And that's apparently where they stepped off the (metaphorical) cliff: as one of our sources put it, they were "writing into their own contract with the hospitals – 70 of the 131 in the state, and mostly small rural ones who need the business – that the hospital would charge competing insurers a higher rate. In other words, not just negotiating the terms of their own contract, but dictating the terms of contracts with competitors." [emphasis added]

It's one thing that your competitors are at a disadvantage - that's the free market, after all - but proactively interfering with your competitors' ability to conduct business is quite another. And that seems to be the case here, and why both the Feds and the State are going after the Blues: the Department of Justice for Sherman Antitrust Act violations, and the Wolverines for violations of that state's statutes.

It's worth noting, by the way, that the Federales have a pretty good batting average on these cases: over the past 16 years, they're 5-0 on health plan MFN cases.

Wednesday, October 20, 2010

My father used to have a saying about the stock market: bulls make money, and bears make money, but pigs go to market. Meaning, "don't be greedy." But that's apparently just what's happened with Michigan Blue Cross Blue Shield:

Several months ago, Hank and I had a discussion about Accountable Care Organizations. What is this concept in Obamacare? As a medical practice manager, I actively read all aspects of Obamacare and how it would affect my profession. In April I attended a Medical Management Seminar, where this policy was discussed. I asked the lawyer leading the discussion what this guideline meant for privately owned businesses. He stated that no one knew what would happen.

I work for one of those doctor-owned medical practices, and Medicare Patients currently account for approximately 20% of the practice. If our practice is not purchased by a hospital before Jan. 2012, my physicians can no longer get paid by Medicare for treating Medicare patients. As with most micro and small businesses, we operate on a tight profit margin. A loss of 20% of our revenue is enough to cause our business to fold. So we have two options: go out of business in Dec. 2011 or negotiate with a hospital to purchase our business. This creates a buyers market, so hospitals can name the price and the physician has to accept or go out of business. Physicians will be forced to accept the pay from a Hospital, or go out of business.

The government, through legislation, will cause the demise of privately owned physician practices.

LexisNexis Top Workers Comp Blogger Julie Ferguson hosts this week's roundup of risky posts. As usual, Julie does an outstanding job of keeping things simple and interesting. And be sure to check out the commercials!

"Did you know that the 236,000 displaced Private Fee for Service members nationwide are eligible for an SEP (Special Election Period) and can enroll now?"

This is an announcement (from Anthem) about the upcoming Special Election Period (no, not that election - although it's relevant); HHS Secretary Shecantbeserious has ordained this unique opportunity for folks being booted from their preferred plans.

This "special" opportunity actually began a few weeks ago (on October 1st), and extends through the end of the year.

Monday, October 18, 2010

Aircraft manufacturer Boeing announced Obamacare has caused them to cut benefits and increase premium contributions. While Obamacrap is not the only reason, it was given at least partial credit. According to the folks at ABC News:

Boeing said deductibles and copayments are going up significantly for some 90,000 nonunion workers.

The company cited three major reasons for the cost shift, including untamed health care inflation, the effects of the new law, and lifestyle issues including being overweight and lack of exercise.

Spokeswoman Karen Forte said Boeing is concerned that its relatively generous plan will get hit with a new tax under the law in 2018, but that the company would have made the changes anyway.

A very nice young lady called the other day, looking for individual health insurance. She's a student at a local university, on her own at the tender age of 18. Her mother has moved out of state, and for a number of reasons, Karen [ed: not her real name] can't be on mom's plan. She is eligible for the university's health plan, but is (understandably) not enthused. She'd really like to have a real plan.

Newly-written plans, and those which have already lost their grandfathered status, "enjoy" these benefits:

■ Expanded Dependent Coverage■ No Annual Dollar or Lifetime Limits■ Expanded Preventive Care■ No Pre-existing Condition Waiting Period for Children under 19■ New Patient Protections■ New Limitations on Rescission

Interestingly, some ostensibly grandfathered plans will also be subject to these provisions, as well; it's not at all clear what benefit their grandfathered status still confers on them.

In related news, Anthem (and perhaps some others) will be offering an "Open Enrollment" period during November. Only two "classes" of insureds are eligible:

■ Adult Dependents (from age 19 to age 28) who are not currently enrolled on a member's policy or who were previously canceled from a member's policy due to age, student or marital status are eligible for enrollment. The member's policy to which the adult dependent will be added must have an effective date prior to September 23, 2010 [ed: in other words, must be grandfathered].

■ A covered family member who previously reached his or her lifetime maximum can enroll for benefits on a member's existing policy during this special period.

We're still awaiting word on how much lower premiums will be due to these enhancements.

It appears that the requirement to report -- set to begin next year (2011) -- is voluntary only for that year. It's anticipated that the IRS will provide more guidance in the future, including clarity for 2012 W-2s. It's also anticipated that it will rain unicorns.

What this (probably) means:

■ If an employee leaves in, say, March 2011, the employer doesn't have to provide the info, but may still choose to do so.

■ When employers (or their payroll services) send out that mass of W-2s in January 2012 (for tax year 2011), this info will still be optional.

■ On the other hand, if an employee leaves in, say, April 2012, the employer does have to provide the info within a few weeks (unless, of course, the IRS pulls an Emily Litella).

■ When employers send out that mass of W-2s in January 2013 (for tax year 2012), this info is no longer optional, (unless - you guessed it - the IRS pulls another Emily L).

Thursday, October 14, 2010

[ed: This post is in loving memory of Robert (Bob) Keller, who passed away yesterday, 10/13/10]

I suspect that most readers will wince when I mention "The Brady Bunch;" the theme song is an almost tribal memory for most of us. In "real life," of course, blended families don't always (or frequently) actually "blend." Because of his indomitable spirit and bottomless heart, my step-dad, Bob Keller, managed that incredible feat.

My father passed away when I was 22; a few years later, Mom found her other true love when she met Bob. I remarked often that it must have been terribly convenient for her: both of her beloved husbands were Roberts. From the moment we met, Bob and I connected and when they wed a few months later, his family and ours had already begun to bond. I still fondly recall our family Chanukah parties, with the kids and the adults all happily chattering and feasting on latkes. Bob had a way of bringing all those who were close to him close to each other.

When our eldest was born, there was no "well, he's a step-grandfather;" he held her proudly and lovingly, as if to announce to the world "hey, look at this!" My daughters knew only love from him, and for him, as did my better half.

I adored him.

For many years, we would meet for lunch every week, often sharing wings at, well, the wing's place. Even more often, we shared our mutual love of rare hamburgers at a local pub (and by rare, I mean "walk it through the kitchen - quickly!" - rare). This was usually preceded by our monthly trip to Max's, where Ralph, our balding barber, would neatly trim us up.

I realized today that Bob had actually been in my life longer than my own father. He was a great dad, a terrific grandfather, and an adoring husband. His first wife, Lynn, had passed several years before he and my mother met, but it was obvious to all who knew him that the size and depth of his heart was enough to deeply love both of his wives.

Thank you, Bob Keller, for your kind, strong hands (oh, did I mention that he was an accomplished wood and stained glass artist?), your bottomless and generous heart, and for the love you shared with my mother, my family, and me.

One problem, of course, is that it doesn't seem to address the issue of when the actual reporting must begin. I've asked our friends at NFIB for their thoughts, and will let our readers know what we find out from them.

Ms Sink, currently running for Governor of the Sunshine State, presently serves as the state's Chief Financial Officer. It's not just that her office thought this was a good idea, but she (apparently) personally signed off on all six applications. And these weren't speeding tickets or spitting on the sidewalk, either:

"(A)pplicants ... had been convicted of, or pleaded guilty to ... Assault on a police officer ... Resisting arrest with violence ... Grand larceny" and several other serious offenses. Florida, as in most states, prohibits convicted felons from obtaining licenses to sell insurance. Unfortunately, these six (that we know of) fellows were approved to sell life and health insurance policies (now there's a scary thought!) to unsuspecting prospects.

Turns out, there is no such law; the relevant section of the Ohio Revised Code (ORC) is silent as to this issue. This discrepancy was pointed out to me by the reporter who wrote the story on which that post was based, Ms Carrie Ghose; she emailed me yesterday to challenge my claim regarding renewals. After poring over the ORC (and checking with other sources), I found, to my dismay, that there is no such provision. I've updated the original post with this information, but in fairness to Ms Ghose, I wanted to make sure that our readers know the facts regarding renewal rates in the Ohio individual medical market.

So there's an increase in demand, fueled by the fact that someone else is footing the bulk of the bill, but what happens when that equation tilts the other way? People make the conscious choice to take a flyer, perhaps understanding that they don't really need that med, after all (not unlike those who choose to go without health insurance). Seems pretty rational to me.

Supporting this thesis is the fact that "(p)atients are deserting prescriptions for the most expensive drugs most often." That makes sense, although one wonders why they even bothered having them filled in the first place. It's not as if the cost, and one's portion of it, is a surprise: the cash register pretty much tells the story. Simple enough to pull an Emily Litella.

To some extent, ignorance of how health insurance works is a factor:

"After switching employers in April, Ms. Brockway said, she chose a high-deductible plan for herself and her 12-year-old son because it took less out of her paycheck ... when she went to pick up asthma medicine for her son and an antidepressant for herself, the pharmacist told her it would cost more than $335."

And?

How much did she save in premiums, and where did that go? How much is her cable bill (if any)? Just once, I'd really like to see so-called "journalists" ask (and report) about what other choices their subjects are making. We have no idea whether Ms Brockway's son has his own cell-phone, for example, and how much that costs. What other discretionary expenses do people make that tells us about their priorities? Why aren't these part of the story, as well?

And there's this: "She returned later and bought a less-expensive prescription for her son." So she did in fact, make the choice to put her son's health first. Why didn't she ask about less expensive medication in the first place? Why didn't the pharmacist (or her doctor) suggest the lower priced alternative? I submit that it's because, until recently, cost wasn't a factor: someone else was paying for it.

The fact is, her high-deductible plan (apparently) worked exactly as advertised, she just didn’t understand how to use it. Once she had "skin in the game," it was to her advantage to begin asking questions, and looking for ways to lower the cost of her (and her son's) health care.

With the completion of PPACA, businesses are focused again at looking for measures to save on rising health care costs. Because of this, businesses are starting to see a place in their employee benefit plans for medical travel.

With the addition of 40 million Americans having access to health insurance, there will be increased demand for health care services. Couple that with an existing shortage of nurses and doctors, queuing for medical care will be a natural by-product.

As the time to see a specialist increases, more individuals will seek to get immediate help through medical travel. Employers and employees will come to understand the high-quality health care that is available to them internationally as they look to end pain and ill health.

The PPACA utilizes similar features as the state-wide Massachusetts plan, which was implemented several years ago. In the Massachusetts plan, queuing for primary and specialty care has more than tripled the wait time for appointments and treatment.

As the low cost option, medical travel will be an attractive network option for employer-based medical plans.

It's tempting to think that the long, heavy "big metal" cars of bygone eras were safer than today's smaller versions. Take, for example, the venerable '59 Chevy Bel Air, its 211 inches weighing in at an impressive 3225 pounds. At the other end of the spectrum, last year's Chevrolet Malibu which, while actually a bit heavier (by about 200 pounds), is about 20 inches shorter. In a head-to-head (literally!) battle, the survisor might surprise you:

Saturday, October 09, 2010

Currently, and since the advent of HIPAA, I can go from a group plan to another group plan, or an individual plan to a group plan, on a guaranteed issue basis, and any pre-existing conditions will be covered immediately.

[ed: Yes, there are a variety of hoops through which to jump, but assume those for sake of discussion]

In order to accomplish this, I need but a simple piece of paper, called a Certificate of Creditable Coverage, which "proves" that I've been covered for (at least) the previous 12 months. Absent this Cert, my new employer's carrier can delay covering any pre-existing conditions for a while.

Yes, yes, Henry. What's your point?

Well, as long as I have that little piece of paper, I can prove prior coverage, which is the point of the exercise, and demonstrates that one can, in fact, prove a positive.

Follow up question: by what mechanism is the new carrier allowed to investigate the veracity of my claim?

Next, we turn our attention to the problem of the child; that is, the fact that one can no longer buy a child-only policy. Carriers which have gone this route (and I'm aware of none that haven't) generally allow a child to be covered if at least one of his parents is also on the policy. Which brings us to Question #2:

What happens when Mom and Junior apply and are issued a policy, and a month later Mom drops coverage on herself?

Follow-up question: by what mechanism would the carrier be allowed to then cancel coverage on Junior?

Is the so-called public option in Obamacare dead? Some don't think so. Left wing blogger Huffington is sporting a post today suggesting there is still hope for those who want a public health insurance option. According to Dr. Abrams who it appears has never practiced medicine nor run a health insurance company, Democrats can still exploit a little publicized provision in Obamacrap to sweep them into office and create even more bureaucracy at the state level.

Apparently no one told Dr. Abrams the states are broke.

Although a federal 'public option' failed to make it into the law, states were granted the power to generate their own public option.

There you have it. Public insurance run by the states. The same states that are complaining about the addition of millions of uninsured's to Medicaid and wondering how care for the masses will be funded without massive tax hikes.

There's your answer.

States, like the federal government, have almost unlimited authority to raise taxes at will. For some reason people seem to think if it comes from the government it must be free. Those are the same people who believe that corporations pay taxes and you can't get pregnant if you do "it" standing up.

If I were running anywhere this year, for governor or state legislature, I would propose that my state enact a public option for itself. Its costs would be negligible, as the federal government provides the necessary subsidies to enable those who cannot afford it to buy it, whether it is from a private insurer or the state.

Costs would be negligible. Gotta love it.

Raise your hand if you believe in subsidies that will last forever, if they even materialize at all. If you raised your hand you probably live in one of the 57 states and voted for having your health insurance premiums lowered by $2,000 and still believe if you like the plan you have you can keep it.

To paraphrase Mark Twain, according to HuffPo, "Reports of the public option being dead are greatly exaggerated".

Although the Whitman-Brown (or is that Brown-Whitman?) race seems to be sucking up all the air in the room, there's another electoral competition going on in the Golden State. In California, the Commisioner of Insurance is an elected position. It's a tough race, but independent insurance agent Rick Bronstein aims to give it all he's got. Rick graciously agreed to an (Exclusive!) email interview with InsureBlog:

InsureBlog (IB): So, Rick, can you tell our readers a bit about yourself (including how long you've been in the insurance business)?

Rick Bronstein (RB): I’ve lived in the Los Angeles area all my life, graduating from UCLA in 1978. I’ve been licensed since August 1977 when I began working in a small P& C agency part time. Ultimately I became the office manager and remained there for 9 years. Since then I’ve worked for a credit union as their insurance department manager, as an outside salesperson for Secure Horizons, and been on my own since 1996.

I enjoy long walks on the beach golf, profitable trips to Las Vegas, and riding my motorcycle [ed: since this is a family-friendly site, no centerfold].

IB: How would you characterize the current state of CA insurance markets? I realize that this is a somewhat loaded question; maybe a little bit about the P&C side, and more on the life/health (especially health) side.

RB: Like most states, mandates and regulations have created more problems than they have solved. Carriers are forced to provide benefits that may not be wanted, and every benefit has a cost.

We have a state run workers compensation company that as part of its mandate is to be revenue neutral to taxpayers. A few months ago our insurance commission sent $5,000,000 to various district attorneys throughout the state to fight fraud. How is that revenue neutral? Insurance companies should fight their own fraud cases.

The insurance commissioner has been holding Anthem Blue Cross “hostage” and has not approved their plans with effective dates after 9/22/10. How is that helping residents of California?

We’ve gone from oversight to over-regulation.

IB: Why run for insurance commissioner instead of, say, letters to the editor, that kind of thing?

Letters to the editor are almost impossible to have published, and if so, are rarely more than one or two paragraphs. While I know it’s unlikely that I will receive more votes than the establishment candidates (Democrat and Republican), at least I can get out the message of allowing a free market to actually be free.

What are your Top 3 goals should you become elected? Or, if you prefer, the first 3 things you plan to address?

The most pressing issue right now is the ObamaCrap that the brain surgeons in Washington passed. So the first 3 things I would do is to encourage the state to do everything possible to have this overturned. Among all the other unconstitutional provisions, the entire bill violates states’ rights.

Since I do not believe the insurance commissioner’s job is to make it more difficult for insurance companies to do business in California, I would reduce the regulations that thwart competition and lead to higher prices.

The third item is to once again allow for gender rating for Medicare Supplements. Several months ago the state required unisex rates which had the effect of raising prices for women on many plans by 20% or more. Once again, regulation where none was needed.

IB: One last question: With all the news out of DC, what do you think about ObamaCare, and specifically as it might effect Californians?

RB: This is a family site, right?

Thanks, Rick, for your forthright answers, and your commitment to fight the good fight. Hopefully, at least some of your ideas will find their way to implementation.

Among these are the opportunity to provide "an additional service to your current clients, and attract new ones, when you offer international health insurance ... International health insurance is a growing market and ... you can add a quoting link to your website that practically does all the work for you!"

WooHoo!

But where would these droves of new (international) clients go for medical care?

"The Tourism Authority of Thailand’s Medical Tourism Blog Contest kicks off with cash and prizes worth nearly US$20,000 up for grabs, including a seven-day all-inclusive medical tour of Thailand for 12 finalists."

Yep, the Thai Tourism agency is sponsoring a blogging contest, with many valuable prizes. Me, I'd settle for a nice dish of pad thai , but I'm a simple guy. But say I was interested (or maybe Bob, Bill or Mike would like a round-trip to an exotic foreign land); what's the deal?

"In order to win, finalists must write the best blog post and attract the highest number of unique visitors."

Hmmm. Could you be more specific?

"The competition is open to anyone who has experience writing blogs related to tourism or medical tourism in English language or containing English language."

Tuesday, October 05, 2010

When Somali pirates [ed: did they actually swash their buckles?] forcibly captured Captain Richard Phillips and his crew last year, the primary concern was, of course, for their safety. But what of the ship's cargo? About a third of the 17 thousand metric tons was "relief supplies bound for Somalia, Uganda, and Kenya."

The other two-thirds, one supposes, were commercial; one further supposes that most, if not all, of that cargo was insured. Regular readers may recall our story from three summers back, detailing how (since-disgraced) insurance carrier AIG put together a veritable A-Team to fight fires threatening their clients' high-end homes.

These are big-dollar (or pound sterling) losses, too: at an average of $4 million a pop, pretty soon you're talking about real booty. The insurers have been thus far underwhelmed by the prowess of their respective countries' official military forces, and have decided to go full Chuck Bronson.

Or not:

"Instead, this private navy would operate under the direct control of the international naval force that is already in the area, with "clear rules of engagement valid under international law."